Managing poor ovarian response in the patient with diminished ovarian reserve.

This month's Views and Reviews provides insights into one of the most difficult clinical care populations: individuals with low ovarian reserve and limited response to stimulation. After a discussion of available definitions of "poor ovarian response" and how new definitions are improving the characterization of the individual patient and our ability to offer prognosis, we review alternative strategies for management. The first chapter presents options for pretreatment, including hormonal manipulation and nutriceuticals. The second chapter discusses the potential benefit of more gentle stimulation in this population. Subsequent chapters address adjuvants during stimulation, alterations of final oocyte maturation and processes in the laboratory, and finally when and how to stop treatment.